Noninvasive Diagnosis of Biliary Disease. Ann Intern Med. 2003;139:I-32. doi: 10.7326/0003-4819-139-7-200310070-00002
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Published: Ann Intern Med. 2003;139(7):I-32.
Bile is a thick fluid secreted by the liver and stored in the gallbladder. It is then released into the upper intestine to help digest food and break down fats. Bile travels from the liver to the gallbladder and the intestine through canals called ducts. Diseases such as stones and cancer can clog the ducts. Doctors can use several tests to diagnose clogged or obstructed biliary tract ducts. Many are “invasive” tests: They require putting a tube down the patient's mouth, injecting dye through a vein, or inserting a needle into the liver. A relatively new noninvasive test is magnetic resonance cholangiopancreatography (MRCP). This test takes detailed pictures of bile and the biliary tract. Many studies have examined the accuracy of MRCP for diagnosing biliary disease compared with other tests. Do these studies show that MRCP is an accurate test in certain situations and not in others?
To summarize results of several studies that looked at how well MRCP detects different types of biliary disease.
4711 patients who had been in 67 studies comparing MRCP with other tests to detect biliary tract obstruction.
Rather than do a new study, the authors searched medical literature published from January 1987 through March 2003. They selected published studies if the study compared MRCP with another standard test for detecting biliary disease. Most of the comparison standard tests were invasive procedures. By using a type of analysis called meta-analysis, the authors grouped and combined the results from all of the studies to see whether MRCP was as good as the other tests in detecting certain types of biliary disease.
MRCP was accurate for detecting biliary tract obstruction and compared well with most other tests. It appeared slightly less sensitive for diagnosing stones (92%) and for distinguishing benign from malignant obstruction (87%) than for identifying the presence (99%) and actual site or level (96%) of obstruction.
Some reviewed studies had weak designs. Some of the accuracy estimates for detecting different types of biliary disease were imprecise.
MRCP is an accurate, noninvasive test for diagnosing biliary tract obstruction. It usually correctly identifies the presence and level of obstruction. However, it detects some causes of obstruction better than others. It appears slightly less sensitive in detecting stones and in distinguishing benign from malignant causes of obstruction.
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Gastroenterology/Hepatology, Biliary Disorders.
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